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September 2018

Caring for Patients With Neurological Impairment: Conversations Between a Pediatrician and Geriatrician

Author Affiliations
  • 1Complex Care Service, Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts
  • 2Harvard Medical School, Boston, Massachusetts
  • 3Division of Geriatric Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
  • 4Hebrew Senior Life, Boston, Massachusetts
JAMA Pediatr. 2018;172(9):795-796. doi:10.1001/jamapediatrics.2018.1079

We are a general pediatrician and geriatrician. One of us specializes in the care of children with medical complexity, and the other specializes in the care of elderly nursing home residents. Despite the fact that we serve patients at the bookends of the age spectrum, our patients and the health care challenges that they face are remarkably similar.

Most of our patients have severe neurological impairment (NI). Among older adults, NI most commonly results from Alzheimer disease or other forms of dementia. In children, NI results from a heterogeneous group of rare diseases, including cerebral palsy, congenital brain malformations, leukodystrophy, and traumatic brain injury. A high prevalence of NI is reported in clinical programs dedicated to serving children with medical complexity.1 Children with severe NI frequently seek help from such programs because their health care needs are not being met elsewhere.

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